NLRP3 and endothelial dysfunction: TMAO is also a significant factor in diabetic kidney disease (DKD) progression, with elevated plasma TMAO levels leading to NLRP3 inflammasome formation and activation in endothelial cells, which then results in endothelial dysfunction, increased monocyte adhesion, and production of pro-inflammatory cytokines in blood vessels, eventually progressing to vascular oxidative stress and DKD.